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Evidence-example-mortalitylongterm-nocorticosteroids.xml

Clinical Decision Support Work Group
Maturity Level: N/A
Standards Status: Informative
Compartments: Not linked to any defined compartments
Raw XML (canonical form + also see XML Format Specification)
Jump past Narrative
No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year) (id = "Evidence-Example-MortalityLongTerm-NoCorticosteroids")
<?xml version="1.0" encoding="UTF-8"?>

<Evidence xmlns="http://hl7.org/fhir">
  <id value="Evidence-Example-MortalityLongTerm-NoCorticosteroids"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative with Details</b> </p> <p> <b> id</b> : Evidence-Example-MortalityLongTerm-NoCorticosteroids</p> <p> <b> title</b> : No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year)</p> <p> <b> status</b> : draft</p> <p> <b> relatedArtifact</b> : </p> <p> <b> description</b> : Occurrence of Mortality with No corticosteroids for patients with sepsis</p> <h3> ReferentGroups</h3> <table> <tr> <td> -</td> <td> <b> Description</b> </td> <td> <b> EvidenceSource</b> </td> <td> <b> IntendedGroup</b> </td> <td> <b> DirectnessMatch</b> </td> </tr> <tr> <td> *</td> <td> Patients with sepsis</td> <td> ???</td> <td> Patients with sepsis</td> <td> ??? <span> (Details : {http://terminology.hl7.org/CodeSystem/directness code 'null' = 'null', given
               as '???'})</span> </td> </tr> </table> <blockquote> <p> <b> variableDefinition</b> </p> <p> <b> description</b> : Mortality Longer term (60 days to 1 year)</p> <p> <b> variableRole</b> : measured variable <span> (Details : {http://terminology.hl7.org/CodeSystem/variable-role code 'measuredVariable'
             = 'measured variable', given as 'measured variable'})</span> </p> <p> <b> actualDefinition</b> : many studies had shorter term outcomes</p> <p> <b> intendedDefinition</b> : Mortality Longer term (Follow up: 60 days to 1 year)</p> <p> <b> directnessMatch</b> : moderate <span> (Details : {http://terminology.hl7.org/CodeSystem/directness code 'moderate' = 'Moderate
             quality match', given as 'moderate'})</span> </p> </blockquote> <blockquote> <p> <b> variableDefinition</b> </p> <p> <b> description</b> : No corticosteroids</p> <p> <b> variableRole</b> : referenceExposure <span> (Details : {http://terminology.hl7.org/CodeSystem/variable-role code 'referenceExposure'
             = 'reference exposure', given as 'referenceExposure'})</span> </p> <p> <b> actualDefinition</b> : ???</p> <p> <b> intendedDefinition</b> : No corticosteroids</p> <p> <b> directnessMatch</b> : ??? <span> (Details : {http://terminology.hl7.org/CodeSystem/directness code 'null' = 'null', given
             as '???'})</span> </p> </blockquote> <p> <b> synthesisType</b> : summary data meta-analysis <span> (Details : {http://terminology.hl7.org/CodeSystem/synthesis-type code 'std-MA' = 'summary
           data meta-analysis', given as 'summary data meta-analysis'})</span> </p> <p> <b> studyType</b> : randomized trial <span> (Details : {http://terminology.hl7.org/CodeSystem/study-type code 'RCT' = 'randomized
           trial', given as 'randomized trial'})</span> </p> <p> <b> statistic</b> : </p> <blockquote> <p> <b> certainty</b> </p> <p> <b> description</b> : Low, due to serious imprecision and indirectness.</p> <p> <b> rating</b> : Low quality <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-rating code 'low' = 'Low quality',
             given as 'Low quality'})</span> </p> <blockquote> <p> <b> certaintySubcomponent</b> </p> <p> <b> note</b> : Note that all studies that reported 90 day to 1 year mortality also reported 28-30 day
             mortality: the CI 95% around the pooled effect for short term mortality also excludes
             no effect: RR 0.91 (CI 95% 0.84 - 0.98).</p> <p> <b> type</b> : Risk of bias <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'RiskOfBias'
               = 'Risk of bias', given as 'Risk of bias'})</span> </p> <p> <b> rating</b> : no serious concern <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern'
               = 'no serious concern', given as 'no serious concern'})</span> </p> </blockquote> <blockquote> <p> <b> certaintySubcomponent</b> </p> <p> <b> type</b> : Inconsistency <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Inconsistency'
               = 'Inconsistency', given as 'Inconsistency'})</span> </p> <p> <b> rating</b> : no serious concern <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern'
               = 'no serious concern', given as 'no serious concern'})</span> </p> </blockquote> <blockquote> <p> <b> certaintySubcomponent</b> </p> <p> <b> note</b> : Only a small proportion of studies reported longer-term mortality.</p> <p> <b> type</b> : Indirectness <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Indirectness'
               = 'Indirectness', given as 'Indirectness'})</span> </p> <p> <b> rating</b> : serious concern <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'serious-concer
              n' = 'serious concern', given as 'serious concern'})</span> </p> </blockquote> <blockquote> <p> <b> certaintySubcomponent</b> </p> <p> <b> note</b> : Confidence interval includes no effect.</p> <p> <b> type</b> : Imprecision <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Imprecision'
               = 'Imprecision', given as 'Imprecision'})</span> </p> <p> <b> rating</b> : serious concern <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'serious-concer
              n' = 'serious concern', given as 'serious concern'})</span> </p> </blockquote> <blockquote> <p> <b> certaintySubcomponent</b> </p> <p> <b> type</b> : Publication bias <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'PublicationBias'
               = 'Publication bias', given as 'Publication bias'})</span> </p> <p> <b> rating</b> : no serious concern <span> (Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern'
               = 'no serious concern', given as 'no serious concern'})</span> </p> </blockquote> </blockquote> </div> </text> <title value="No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year)"/> 
  <status value="draft"/> 
  <relatedArtifact> 
    <type value="derived-from"/> 
    <url value="https://app.magicapp.org/public/guideline/EZ1w8n/pico/31831/widget?tab=outcome"/> 
  </relatedArtifact> 
  <description value="Occurrence of Mortality with No corticosteroids for patients with sepsis"/> 
  <referentGroup> 
    <description value="Patients with sepsis"/> 
    <evidenceSource> 
      <type value="Group"/> 
      <display value="???"/> 
    </evidenceSource> 
    <intendedGroup> 
      <type value="Group"/> 
      <display value="Patients with sepsis"/> 
    </intendedGroup> 
    <directnessMatch> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/directness"/> 
        <display value="???"/> 
      </coding> 
    </directnessMatch> 
  </referentGroup> 
  <variableDefinition> 
    <description value="Mortality Longer term (60 days to 1 year)"/> 
    <variableRole> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/> 
        <code value="measuredVariable"/> 
        <display value="measured variable"/> 
      </coding> 
    </variableRole> 
    <actualDefinition> 
      <type value="EvidenceVariable"/> 
      <display value="many studies had shorter term outcomes"/> 
    </actualDefinition> 
    <intendedDefinition> 
      <type value="EvidenceVariable"/> 
      <display value="Mortality Longer term (Follow up: 60 days to 1 year)"/> 
    </intendedDefinition> 
    <directnessMatch> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/directness"/> 
        <code value="moderate"/> 
        <display value="moderate"/> 
      </coding> 
    </directnessMatch> 
  </variableDefinition> 
  <variableDefinition> 
    <description value="No corticosteroids"/> 
    <variableRole> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/> 
        <code value="referenceExposure"/> 
        <display value="referenceExposure"/> 
      </coding> 
    </variableRole> 
    <actualDefinition> 
      <type value="EvidenceVariable"/> 
      <display value="???"/> 
    </actualDefinition> 
    <intendedDefinition> 
      <type value="EvidenceVariable"/> 
      <display value="No corticosteroids"/> 
    </intendedDefinition> 
    <directnessMatch> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/directness"/> 
        <display value="???"/> 
      </coding> 
    </directnessMatch> 
  </variableDefinition> 
  <synthesisType> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/synthesis-type"/> 
      <code value="std-MA"/> 
      <display value="summary data meta-analysis"/> 
    </coding> 
  </synthesisType> 
  <studyType> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/study-type"/> 
      <code value="RCT"/> 
      <display value="randomized trial"/> 
    </coding> 
  </studyType> 
  <statistic> 
    <description value="371 per 1000"/> 
    <note> 
      <text value="371 per 1000 experienced Mortality (60 days to 1 year)"/> 
    </note> 
    <statisticType> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/statistic-type"/> 
        <code value="C44256"/> 
        <display value="proportion"/> 
      </coding> 
    </statisticType> 
    <quantity> 
      <value value="0.371"/> 
    </quantity> 
    <sampleSize> 
      <note> 
        <text value="Based on data from 6438 patients in 9 studies "/> 
      </note> 
      <numberOfStudies value="9"/> 
      <numberOfParticipants value="6438"/> 
    </sampleSize> 
  </statistic> 
  <certainty> 
    <description value="Low, due to serious imprecision and indirectness."/> 
    <rating> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/> 
        <code value="low"/> 
        <display value="Low quality"/> 
      </coding> 
    </rating> 
    <certaintySubcomponent> 
      <note> 
        <text value="Note that all studies that reported 90 day to 1 year mortality also reported 28-30 day
         mortality: the CI 95% around the pooled effect for short term mortality also excludes
         no effect: RR 0.91 (CI 95% 0.84 - 0.98)."/> 
      </note> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type"/> 
          <code value="RiskOfBias"/> 
          <display value="Risk of bias"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </certaintySubcomponent> 
    <certaintySubcomponent> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type"/> 
          <code value="Inconsistency"/> 
          <display value="Inconsistency"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </certaintySubcomponent> 
    <certaintySubcomponent> 
      <note> 
        <text value="Only a small proportion of studies reported longer-term mortality."/> 
      </note> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type"/> 
          <code value="Indirectness"/> 
          <display value="Indirectness"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating"/> 
          <code value="serious-concern"/> 
          <display value="serious concern"/> 
        </coding> 
      </rating> 
    </certaintySubcomponent> 
    <certaintySubcomponent> 
      <note> 
        <text value="Confidence interval includes no effect."/> 
      </note> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type"/> 
          <code value="Imprecision"/> 
          <display value="Imprecision"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating"/> 
          <code value="serious-concern"/> 
          <display value="serious concern"/> 
        </coding> 
      </rating> 
    </certaintySubcomponent> 
    <certaintySubcomponent> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type"/> 
          <code value="PublicationBias"/> 
          <display value="Publication bias"/> 
        </coding> 
      </type> 
      <rating> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating"/> 
          <code value="no-concern"/> 
          <display value="no serious concern"/> 
        </coding> 
      </rating> 
    </certaintySubcomponent> 
  </certainty> 
</Evidence>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.